Introduction: Metastatic Crohn's disease (MCD) is an extraintestinal manifestation of Crohn's disease, with biopsy as fundamental diagnostic tool. There are few References to MCD in children, with a 0.5-1% estimated incidence in adults. There is no consensus about its therapeutic approach. We describe our diagnostic and therapeutic experience in MCD. Case Reports: Four cases of MCD are described in our Pediatric Gastroenterology Unit in a tertiary care hospital. The age at diagnosis was between 7 and 13 years. Lesions appeared before the diagnosis of Crohn's disease in three of them, and during the course of the disease in another one, with genital location in three patients and bilateral pretibial region in the other. All four cases demonstrated non-caseificant granulomas on biopsy. Only two patients used exclusive enteral nutrition therapy with complete resolution, while other two cases received a combination of therapies (corticosteroids, azathioprine, tacrolimus, infliximab and adalimumab) because of recurrence. Only one case required surgery after poor clinical control. Discussion: The MCD is infrequent but must always be included in the differential diagnosis of cutaneous lesions in Crohn's disease, considering it could be the debut of the disease. We will rely on biopsy anyway for definitive diagnosis. In this series the genital region is verified as the most commonly affected in children. The therapeutic approach does not differ from the management of intestinal involvement.

Introducción: la enfermedad de Crohn metastásica (ECM) constituye una manifestación extraintestinal de la enfermedad de Crohn, siendo fundamental la biopsia para su diagnóstico. Existen referencias escasas a ECM en la edad pediátrica, y en adultos se estima una incidencia del 0,5-1%. No hay consenso sobre su abordaje terapéutico. Nuestro objetivo es describir nuestra experiencia diagnóstica y terapéutica en ECM. Caso clínico: se describen 4 casos de ECM en seguimiento en una Unidad de Gastroenterología Infantil en un hospital pediátrico de tercer nivel. Edades al diagnóstico entre 7 y 13 años. Las lesiones aparecieron antes del diagnóstico de enfermedad de Crohn (EC) en tres de ellos y durante la evolución de la enfermedad en otro. Localización genital en tres pacientes y en región pretibial bilateral en el otro. Todos demostraron granulomas no caseificantes en la biopsia. Dos pacientes precisaron únicamente nutrición enteral exclusiva, observándose resolución completa, mientras que otros dos recibieron terapias combinadas (corticoides, azatioprina, tacrolimus, infliximab y adalimumab) por recurrencia. Solo un caso requirió cirugía por mal control clínico. Discusión: la ECM es una entidad rara aunque siempre debemos incluirla en el diagnóstico diferencial de las lesiones cutáneas en enfermedad de Crohn, teniendo en cuenta que puede ser el debut de la enfermedad. Nos basaremos en la biopsia en cualquier caso para el diagnóstico definitivo. En esta serie se verifica la región genital como la más habitual en niños. El abordaje terapéutico no difiere del manejo de la afectación intestinal.

Introduction: The conventional 24-hour pH monitoring is the gold standard for the diagnosis of gastro-esophageal reflux (GER), a possible cause of Apparent Life Threatening Episodes (ALTE). However, multichannel intraluminal impedance (MII) may provide advantages. Objectives: Comparison of the results of MII and pH monitoring in patients undergoing MII-pH monitoring in the 3-year study period because of having suffered from ALTE. Material and methods: Prospective study of MII-pH monitoring performed in our unit to infants < 12 months of age admitted for ALTE for a 3-year period. Results: Thirty nine patients studied. 2,692 pH monitoring episodes, with median of 24 (IQ: 15-44) episodes/patient, 1.30 (IQ: 0.80-2.60) reflux/hour, 1 (IQ: 0-4) reflux episode > 5 min per patient and clearance of 1.20 (IQ: 0.70-2.20) min/reflux. With pH monitoring analysis, 14 children (35.9 %) could have been diagnosed as GER (8 mild, 4 moderate and 2 severe) based on the classical criteria. MII identified a total of 8,895 events; only 3,219 among them were refluxes, with a median of 75 (IQ: 54-111) per patient, 1.30 (IQ: 1.3-2.6) episodes/hour). With MII-pH monitoring combination there were 21.60 (SD 15.21) acid reflux episodes, 67.33 weekly acid (SD 32.09) and 3.34 (SD 7.23) non-acid, being finally diagnosed 33 patients as GER. Conclusions: The association of pH monitoring and MII provides additional information that improves GER diagnostic performance without posing any additional risk to the infant patient. The non-acid/weekly acid refluxes, not detected by pH monitoring, account for a high percentage of episodes, this may have diagnostic and therapeutic significance, especially in infants. Further studies are needed to assess the normality of MMI in pediatric patients.

Introducción: la pHmetría convencional de 24 horas constituye el patrón de oro para el diagnóstico de episodios de riesgo vital aparente (ALTE). La impedanciometría intraluminal multicanal (IIM) puede aportar ventajas en el lactante. Objetivos: comparación de los resultados de IIM y pHmetría en los pacientes sometidos a IIM-pHmetría en el periodo de estudio por causa de estudio de ALTE. Material y métodos: estudio retrospectivo de IIM-pHmetrías realizadas en nuestro servicio a lactantes < 12 meses de edad ingresados por ALTE durante tres años. Resultados: 39 pacientes estudiados. La pHmetría registró 2.692 reflujos, con medianas de 24 (IQ: 15-44) reflujos/paciente, índice de reflujo de 1,30 (IQ: 0,80-2,60) reflujos/hora, 1 (IQ: 0-4) episodio de reflujo > 5 min por paciente y aclaramiento de 1,20 (IQ: 0,70-2,20) min/reflujo. Por pHmetría 14 niños (35,9 %) fueron diagnosticados de RGE. Mediante IIM se registraron 8.895 eventos; 3.219 fueron reflujos, con mediana de 75 (IQ: 54-111) reflujos/paciente, 1,30 (IQ: 1,3-2,6) reflujos/hora. Mediante IIM-pHmetría, la media de reflujos ácidos por paciente fue de 21,60 (DE 15,21), débilmente ácidos 67,33 (DE 32,09) y no ácidos 3,34 (DE 7,23), pudiéndose diagnosticar finalmente a 33 pacientes de RGE. Conclusiones: la asociación de IMM y pHmetría proporciona información adicional que mejora el rendimiento diagnóstico, sin suponer ningún riesgo adicional para el paciente. Los reflujos no ácidos/débilmente ácidos, los cuales no son detectados mediante pHmetría, suponen un porcentaje elevado, sobre todo en lactantes; esto tiene gran importancia diagnóstica en el estudio del ALTE. Aún son necesarios estudios para valorar la normalidad en IIM en pacientes pediátricos.

As fraturas do anel pélvico compõem de 2% a 8% de todas as lesões do esqueleto, incidência que sobe para 25% nos politraumatizados e representa fator prognóstico negativo no que diz respeito à morbidade e à mortalidade. Buscou-se com este trabalho estabelecer se houve mudança do perfil desses pacientes nas últimas décadas e por que ela ocorreu. Para tanto, avaliaram-se epidemiologia, mecanismo de trauma e tipos de fratura, por revisão bibliográfica nas bases de dados indexadas relacionadas ao tema, selecionados 20 trabalhos que continham os requisitos para o estudo. O período entre janeiro de 1987 e dezembro de 1999 (primeira década) e outro de janeiro de 2000 a dezembro de 2010 (segunda década) foram analisados e comparados estatisticamente pelo Teste de Mann-Whitney. As classificações de Tile, Young Burgess e AO foram adequadas para permitir sua categorização. As pesquisas em cada uma das décadas foram homogêneas. Na primeira, as lesões foram mais prevalentes em homens, com 62,5%, com tendência a inversão desse padrão, dado o aumento de mulheres acometidas na segunda década (p = 0,286). A média de idade na primeira década era de 39,3 anos e revelou um aumento na segunda (p = 0,068). Os mecanismos de trauma mais prevalentes foram aqueles relacionados ao tráfego nos períodos, assim como as fraturas classificadas como do tipo A (p = 0,203ep= 0,457, respectivamente). Os índices de mortalidade diminuíram (p = 0,396). Conclui-se que houve tendência ao aumento na média de idade dos pacientes (p = 0,068). Já o crescente acometimento das mulheres (p = 0,286) e a diminuição da mortalidade (p = 0,396) não foram significantes.

The pelvic ring fractures comprise 2 -8% of all skeletal injuries. As the incidence rises to 25% in polytrauma and represents a negative prognostic factor with regard to morbidity and mortality of patients, we sought with this work to establish the profile of these, compared to an alteration in the profile of patients with pelvic ring fractures in recent decades. To this end, we evaluated the epidemiological profile, mechanism of injury and types of fractures. By reviewing the literature indexed in the databases related to the theme, 20 papers were selected that contained the requirements for the study. For the period between January 1987 and December 1999 (first decade), and another period in January 2000 and December 2010 (second decade), data were analyzed by Mann -Whitney test. The ratings Tile, Young and Burgess AO were adequate to permit their categorization. The research in each decade was homogeneous. At first the lesions were more prevalent in men with 62.5% with a tendency to reverse this pattern given the increase of women in the second decade (p = 0.286). The average age in the first decade was 39.3 years, an increase in the second (p = 0.068). The most prevalent mechanisms of trauma were related to traffic in both periods as well as fractures classified as type A (p = 0.203 and p = 0.457, respectively), having mortality rates decreased (p = 0.396). We conclude that there was a tendency to increase in the average age of patients (p = 0.068); however the increasing involvement of women (p = 0.286) and decreased mortality (p = 0.396) were not significant.

OBJETIVO: Analisar se existe relação entre os fatores moleculares dos genes GTS e a mortalidade dos pacientes com câncer de tireoide dado pelo índice AMES de prognóstico clínico. MÉTODOS: Foram coletadas amostras da tireoide de 66 pacientes com carcinoma papilífero (53 mulheres e 13 homens), de modo a permitir extração do material genético das enzimas. Foram constituídos dois grupos, segundo os fatores prognósticos clínicos de alto e baixo risco, de acordo a classificação AMES. Cada grupo foi avaliado pela presença ou não do genótipo nulo para as enzimas estudadas, correlacionando-os com os fatores prognósticos clínicos (AMES). RESULTADOS: Foram analisados os resultados de 17 doentes com alto risco (grupo A) e 49 com baixo (grupo B). Todas combinações de genótipos do GSTT1 e GSTM1 foram encontrados. O genótipo nulo dos dois genes do grupo de alto risco foi encontrado em 5,8% e no de baixo risco em 6,1%. CONCLUSÃO: A presença ou deleção dos genes GST (GSTT1 e GSTM1) não são bom fatores prognósticos no câncer papilífero da tireoide.

PURPOSES: Analyze the relationship between the AMES classification and molecular factors from Glutation-S-Transferase System, specifically the GSTT1 and GSTM1 in patients with well differentiated thyroid cancer. METHODS: Samples of thyroid tissue of 66 patients with papillary thyroid carcinoma were obtained (53 women and 13 men). Patients were divided in two groups (high and low risk) according to the AMES classification. In each group, presence of the null genotype of both GST enzymes system was studied. These results were compared with the AMES classification. Samples were obtained in the operating room immediately after thyroidectomy, placed in cryotubes, immersed in liquid nitrogen and stored in a freezer at -80ºC. DNA of this enzymes was extracted by the fenol-cloroformium method. RESULTS: There were 17 high risk patients and 49 low risk patients. The null genotype of the high risk group was 5.8% and in the other group was 6.1%. CONCLUSION: There was no relationship between absence of genes GSTT1 and GSTM1 and prognosis of the papillary thyroid carcinoma when compared to the AMES classifications.